More Nip-Tuck, More Years Off Aging Face

— More extensive facial surgery predicted a younger estimated age for patients who underwent one, two, or three surgical procedures, investigators reported.

by Charles Bankhead,Staff Writer, MedPage Today
February 20, 2012

MedpageToday

More extensive facial surgery predicted a younger estimated age for patients who underwent one, two, or three surgical procedures, investigators reported.

Overall, patients looked an average of 8.9 years younger than their chronological age after surgery, in the opinion of raters who viewed before and after pictures.

The difference between pre- and postsurgical estimates increased with the number of procedures, as reported online in Archives of Facial Plastic Surgery.

Action Points

For most patients visiting a plastic surgeon, the goal of aesthetic facial surgery is to improve one's appearance and to attempt to "turn back the clock."

This study attempts to provide objective evidence for the fact that patients actually look more youthful following facial surgery and to quantify the degree of perceived age change.

"Our study is novel in that it quantifies the degree of perceived age change after aging face surgical procedures and demonstrates a significant and consistent reduction in perceived age after aesthetic facial surgery," Nitin Chauhan, MD, of the University of Toronto, and co-authors wrote in conclusion.

"This effect is more substantial when the number of surgical procedures is increased, an effect unrelated to the preoperative age of a patient and unaffected by other variables that we investigated."

Facial plastic surgeons have a major challenge and a delicate task in managing patient expectations regarding outcomes, and most studies have focused on patient-reported outcomes.

Yet, age and age change after surgery as perceived by others are the best barometers of success after facial plastic surgery, the authors wrote in their introduction.

To develop an objective measure of surgical success based on perceived age change, Chauhan and colleagues recruited 60 patients who had undergone various facial surgical procedures and who agreed to allow use of before and after photos in the study.

A group of 40 first-year medical students served as raters, who estimated patients' age before surgery and the perceived change in age after surgery. The raters were divided into four groups of 1o, and each rater viewed all 60 patients before and after photos, which were distributed randomly among the groups.

In a pilot phase of the study, the investigators developed a statistical model to account for variability in raters' ability to guess patient ages. The model also was tested to assess the effects of preoperative chronological age, rater group, and photograph viewing order. Ultimately, the model showed no significant differences in the raters' ability to predict ages.

The patients had a mean age of about 60, and all but six of the participants were women. Records showed that 22 patients underwent a face and neck lift, 17 underwent face/neck lift plus upper and lower blepharoplasty, and 22 had face/neck lift, blepharoplasty, and forehead lift.

The mean perceived age of all 60 patients was 1.73 years younger than their composite chronological age. The difference increased to 8.9 years after surgery, resulting in a mean change in perceived age of 7.18 years for the entire group.

For patients who had only a face/neck lift, the mean estimated preoperative age was 1.88 years less than the patients' chronological age. The mean postoperative age was 7.62 years younger, resulting in a net change in perceived age of 5.74 years.

For patients who had two procedures, the difference between perceived and actual age was 3.91 years before surgery and 11.42 years afterward, resulting in a 7.51-year net decrease in perceived age.

Patients who had all three procedures were judged to look slightly older than they were (0.2 years). Postoperatively, they were perceived to be 8.21 years younger than they were, leading to a net change of 8.41 years.

A general linear model of the three surgical procedures showed a significant difference (P=0.007). Between-group differences achieved significance only for the comparison of one versus three surgical procedures.

"Our findings offer some objective sense as to our success with surgical intervention as facial plastic surgeons and provide us with more evidence to give patients when formulating their preoperative expectations," the authors wrote in their discussion of the findings.

"Although motivations for aesthetic surgery may vary, a prevailing concept includes the desire to achieve a more youthful refreshed appearance while maintaining one's unique attributes and identifying characteristics," they added. "Given these expectations, a mean 7.2-year reduction in perceived age difference is indeed consistent with this goal."

The authors acknowledged limitations that might restrict the generalizability of the results: single-surgeon experience and limited number of surgical techniques.

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